External/side knee joint pain is a pain that is mainly (but not always exclusively) concentrated in the outer part of the knee joint. This includes pain in the area of the outer thigh and lower leg, the outer ligament, the surrounding soft tissues, the outer knee joint gap and the head of the fibula (caput fibulae). Outer knee joint pain can be caused by direct damage to the anatomical structures involved, or it can occur as a secondary pain, when damage occurs at an anatomically distant location. An example of a cause is the extension of the external ligament.
Causes of knee pain on the outside
If the training is interrupted, the pain disappears by itself within a few hours or until the next day. In this case the training plan should be reduced and the training intensity should be increased more slowly. Another source of pain when jogging is a faulty running technique with a severely bent knee or worn running shoes.
In this case, a consultation in a specialist shop with treadmill analysis can provide information. One of the physical causes is a muscular imbalance, especially in the thigh muscles. The stability of the hip joint and ankle joint also plays a decisive role for a painless, undisturbed movement.
An unevenly developed thigh musculature results in different degrees of tension, which causes the kneecap to deviate to the side and can cause pain. In addition, the muscular tension is perceived as painful. If the foot muscles or the hip muscles are only weakly developed, the leg axis twists.
This twisting again results in incorrect loading of the knee joint, which is painful. If such a muscular problem is the cause, specific exercises of the weak muscle groups can lead to a considerable improvement. A more difficult problem is a permanent deviation of the leg axis.
Especially with the knock-knees, the area of the outer knee joint is put under greater strain. Sports such as jogging worsen the problem due to the additional impact load. In this case, one can try to counteract the leg malposition with adapted running shoes.
Under no circumstances should training be maintained when pain is experienced, as long-term damage such as osteoarthritis of the knee joint is imminent. The runner’s knee (iliotibial ligament syndrome, ITBS, tract chafing) occurs more frequently in a bowleg position, causing the iliotibial ligament to chafe and irritate the outer bones of the knee joint. In addition to an inflammation of the ligamentous apparatus and the periosteum, bursae in the surrounding area can also become inflamed.
With training breaks until painless and anti-inflammatory ointments the problem improves. Finally, an injury to the knee structures must be considered. Injuries to the outer meniscus or ligaments can also lead to considerable pain under stress and should be ruled out by a doctor.
These diseases are described in more detail below
- Bow legs or knock knees
- Torn outer meniscus
- Outer ligament injury
- Iliotibial Ligament Syndrome
- Knee joint arthrosis
In contrast to the bow legs, the knee joints of the bow legs are shifted outwards in the axis. Affected persons can put the ankles together with stretched legs, but the knee joints do not touch each other. Due to this axial shift, the bow legs put more strain on the inner (=medial) knee joint.
There, damage to the meniscus or the cartilage layer can occur, so that after a longer period of loading, pain occurs primarily in the inner knee joint. With the knock-knee, the leg axis is typically not completely straight. Instead, the knee joints are shifted slightly inwards compared to the hip.
You can test this by trying to stand with stretched legs. If the knees touch each other, but you cannot bring the ankles together, you probably have bow legs. Because of the shifted leg axis there is a higher load on the outer (=lateral) knee joint.
Usually, complaints only occur after many years of stress. The cause can be meniscus or cartilage damage, after a longer period of time arthrosis can also develop. Pain in the knee can be triggered by various mechanisms when walking or jogging.
If someone is not accustomed to the strain, a short-term overload is usually the cause of the pain on the outside of the knee. For example, muscles can be hardened or tense. When hiking for several days, sore muscles on the outside of the thigh can also be the cause.
On the other hand, if you hike and run a lot, you must think of chronic damage to the structures in the knee joint. In the case of external knee pain, the outer meniscus can be affected. Cartilage damage is also a possible cause.
The iliotibial ligament syndrome (ITBS) is a widespread pain syndrome of the knee joint, which occurs after or during a load. Due to the increased incidence in runners, this clinical picture is also called runner’s knee. The tractus iliotibialis, from which the name ilio-tibial ligament syndrome (ITBS) is derived, is a strip of connective tissue surrounding the outer muscles of the thigh.
It runs from the pelvic muscles via the knee joint and a bony protrusion at the knee joint to the tibia. It serves to stabilize the thigh bone under load. In ilio-tibial ligament syndrome (ITBS), the strip of connective tissue (tractus iliotibialis) rubs against the bony protrusion of the knee joint.
Rubbing the strip of connective tissue (tractus iliotibialis) against the bony prominence of the knee joint causes stabbing pain on the outside of the knee joint. Initially, the pain only occurs under increased strain, for example during or after jogging. Later, the pain can become noticeable when climbing stairs or even when simply walking.
The pain can become so severe that further movement of the leg is impossible and thus lead to a severe physical limitation of the affected person. The cause of ITBS is irritation of the sensitive periosteum surrounding the knee joint and the bony prominence at the knee joint. Frequent bending and stretching of the knee joint, as is the case when jogging or climbing stairs, for example, leads to rubbing of the connective tissue strip (tractus iliotibialis) against the bony projection of the knee joint and thus to irritation of the periosteum with the characteristic pain.
Various anatomical changes, such as malpositioning of the feet or weakness of the pelvic muscles, can promote the development of ilio-tibial ligament syndrome (ITBS). Acute pain should be treated with cold, for example in the form of ice packs and cooling anti-inflammatory ointments. In addition, the exercise that leads to the symptoms (e.g. jogging) should be stopped.
If the above measures fail, there is also the possibility of surgery. Here the strip of connective tissue (tractus iliotibialis) is incised in a z-shaped manner. This lengthens the strip, which relieves the knee joint.
During patellal lateralisation, the kneecap (=patella) is shifted outwards (=lateral). As a result, the patella no longer lies completely in its usual slide bearing. The reason for this is usually a weakness in the holding structures of the patella, including the collateral ligaments and the thigh muscles.
When the knee joint is moved, the kneecap not only slides with its cartilaginous part over the thigh bone, but instead the thigh bone rubs against the bone of the kneecap or destroys the protective cartilage. In the long run this leads to a so-called lateral retropatellar arthrosis. The outer (=lateral) part of the cartilage behind the kneecap (=retropatellar) is worn out.
The sensitive bone of the patella is not sufficiently protected, which is why bending the knee causes pain on the outside. In case of a dislocated patella, the patella springs out of its normal sliding bearing at the knee. This is characterised by sudden and severe pain at the first moment.
In most cases, various other structures of the knee joint are also affected. This can lead to cartilage damage to the kneecap, thigh or lower leg bone. Vessels or ligaments in the knee joint can also be affected.
This can cause pain, some of which can last for a long time, especially during movement. Under certain circumstances, surgery on the affected structures may also be necessary. Immediately after the kneecap pops out, a bruise often forms, which causes severe restrictions in movement and pain.
- Synonyms: External meniscus rupture, external meniscus lesion, external meniscus degeneration, external meniscus damage, external meniscus disease
- Place of greatest pain: In the area of the outer knee joint gap. – Pathology/Cause: Accident-related or wear-related (degenerative) tear of the outer meniscus or outer meniscus ganglion. – Age: can occur at any age
- Accident: Twisting trauma (accident) of the knee joint during sports activities.
In the case of degenerative tears usually no recurrent trauma. – Type of pain: Stabbing, light to dull, pulling. Possibly limited, partially blocked knee joint mobility.
Penetrating stabbing pain after rotational movements of the leg. – Origin of pain: After trauma (accident) sudden, otherwise also slowly increasing or recurring with pauses. – Occurrence of pain: Especially under stress, squatting position or after unfavorable rotary movements of the knee joint.
If the meniscus gets jammed in the knee joint, the knee can no longer be fully extended and permanent pain can occur. – External aspects: With acute injury mostly stronger swelling. In the case of degenerative tears, load-dependent, less swelling, sometimes none.
- Synonyms: Osteoarthritis of the external compartment, lateral gonarthrosis…
- Place of greatest pain: In the area of the lateral/external knee joint gap. – Pathology /Cause: Wear-related cartilage damage to the knee with inflammation of the mucous membrane with main damage in the area of the outer knee joint. – Age: advanced age (> 50 years).
In over 80% of those over 60 years of age, wear-related changes can be detected in the X-ray image of the knee joint. – Type of pain: Stabbing, light to dull, pulling. Feeling of stiffness in the knee joint.
Possibly limited knee joint mobility. – Origin of pain: Slowly increasing, sometimes stabbing, sometimes pulling, depending on the stage of arthrosis. – Occurrence of pain: Pain in the morning.
Increase in pain under stress (with increasing walking distance). – External aspects: Swelling, possible overheating. Often knock-knees (genu valgum).
- Synonyms: Rupture of external ligament, injury to external ligament, damage to lateral collagenous ligament. – Place of greatest pain: In the course or insertion/origin of the external ligament. – Pathology /cause: Overstretching or tearing of the external ligament.
- Age: Mostly younger people who are active in sports. – Accident: Yes. Usually it is a so-called varus trauma.
This means that the knee joint is forced into an O – leg position. If the reserve of stretch of the outer ligament (Ligamentum collaterale laterale) is exceeded, the ligament is torn or torn. – Type of pain: stabbing, light, on the outside
- Origin of pain: Suddenly.
Often in the context of football injuries. – Occurrence of pain: Related to the injury. Pain when checking the stability of the outer ligament.
Possible instability of the knee joint to the outside. – External aspects: Lateral, possibly general knee swelling. – Synonyms: Inflammation of the tractus iliotibialis (ITBS = Iliotibial Ligament Syndrome or tractus abrasion).
- Location of the greatest pain: At the lateral thigh roll. – Pathology/Cause: Rubbing of the tractus iliotibialis (tendon-like thigh sheath) against the thigh. – Age: Mostly younger persons who are active in sports.
- Type of pain: stabbing
- Pain development: slow
- Pain occurrence: Stress-related. Often when jogging. – External aspects: Preferred occurrence with O – legs. The knee malposition causes the outer knee joint to protrude, which promotes chafing of the tractus.